Athetosis: Causes, Symptoms, and Acupuncture Treatment

Athetosis is a syndrome characterized by muscle rigidity and slow, tonic extension-flexion movements of the hands and feet.

Athetosis can be classified into two major categories: idiopathic and symptomatic.

The condition is of unknown etiology, characterized by bilateral athetosis with varying degrees of increased muscle tone, often accompanied by intellectual disability. This disorder is mostly congenital, with onset within the first few months after birth. Abnormal movements appear in the face, head, and limbs. Intellectual development is delayed; speech is late or entirely absent. Walking is difficult, with spastic increased muscle tone in the lower limbs during gait, hyperactive tendon reflexes, but no true paralysis. This disease has three main signs: athetosis, increased muscle tone, and intellectual impairment. It may be accompanied by difficulty in phonation, chewing, and swallowing, as well as involuntary laughter and crying, and signs of pseudobulbar palsy. The primary pathological changes are located in the putamen and caudate nucleus (i.e., the striatum), which exhibit a marble-like appearance (status marmoratus).

II. Symptomatic

1. Cerebral Palsy: Cerebral palsy is a common cause of athetosis. It results from brain damage occurring during the fetal period, the perinatal period, or at birth (e.g., preterm birth, trauma during pregnancy, hypoxia during delivery, severe neonatal jaundice). In addition to athetosis, patients often present with various mental and psychiatric symptoms, such as mild hemiparesis on the side affected by athetosis, pyramidal tract signs, bilateral athetosis accompanied by spastic quadriparesis, and frequently concurrent mental disorders or epilepsy.

2. Adult post-stroke athetosis: This is part of the thalamic syndrome. Other degenerative diseases such as lenticular nucleus degeneration and progressive pallidal atrophy can also present with athetosis. Among inflammatory diseases, encephalitis lethargica, pertussis, measles, and diphtheria also [can manifest with athetosis].

Can cause.

[Key Diagnostic Points]

The clinical manifestations mainly include the following three aspects:

1. Athetosis of the hands and feet (手足徐动)

The condition typically presents as athetosis, affecting one side of the limbs or all four extremities. The symptoms initially manifest distally, beginning with continuous, slow, serpentine, and bizarre movements of the fingers. The metacarpophalangeal joints are hyperextended, and the fingers twist into contortions, occasionally forming a special posture resembling a “Buddha’s hand.” When the lower limbs are involved, the hallux often exhibits spontaneous dorsiflexion. When the facial muscles are affected, the patient makes grimaces and contorts their face into various “funny faces.” Involvement of the pharyngeal and lingual muscles leads to slurred speech, difficulty swallowing, and impaired chewing. These symptoms typically intensify during mental stress and disappear upon falling asleep.

2. Increased Muscle Tone

It increases during standing and movement, while muscle tone decreases in the resting state. In severe cases, it may even reach the degree of contracture, presenting with a “cock-like” gait during activity. Such symptoms disappear after falling asleep.

3. Cognitive Impairment (Zhìnéng Zhàng’ài)

Manifestations include low intelligence, sluggish responsiveness, clumsy hands and feet, and dementia, among others.

【Treatment】

1. Acupoints and Needling Techniques

1. **GV20 (Baihui)**: Located 7 *cun* directly above the midpoint of the posterior hairline, in the depression at the vertex of the head directly above the apex of both ears. A 30-gauge, 1.5 *cun* filiform needle is used. After routine local disinfection, insert obliquely slightly backward and downward approximately 1 *cun* until contacting the bone. Needling sensation: distension and pain at the vertex.

2. GV16 (Fengfu): Located 1 cun directly above the midpoint of the posterior hairline, in the depression between the two trapezius muscles. Use a 30-gauge, 1.5 cun filiform needle. After routine local disinfection, insert perpendicularly toward the foramen magnum to a depth of about 1.3 cun. Needling sensation: local distension and pain.

3. TE17 (Yifeng), bilateral: Located in the depression between the mandibular angle and the mastoid process, posterior to the earlobe. Two filiform needles of gauge 30 and 2 cun in length are selected. After routine local disinfection, the needles are inserted obliquely toward the posteromedial aspect of the mandible to a depth of approximately 1.6 cun. Needling sensation: local distension and pain.

4. LI4 (Hegu), bilateral: Located on the dorsum of the hand, between the 1st and 2nd metacarpal bones, near the radial side of the 2nd metacarpal bone.

At the midpoint of the lateral edge; take two No.30 gauge 2-cun filiform needles. After routine local disinfection, insert approximately 1.8 cun towards SI3 (Houxi). Needle sensation: local distension and pain.

5. BL23 (Shenshu), bilateral: Located on the lower back, 1.5 cun lateral to GV4 (Mingmen), which lies in the depression between the spinous processes of the 2nd and 3rd lumbar vertebrae. Use two filiform needles of gauge 30, 2 cun in length. After routine local disinfection, insert perpendicularly to a depth of approximately 1.8 cun. Sensation: local distension and pain.

6. ST36 (Zusanli, bilateral): Located 3 cun below ST35 (Dubi), one finger-width (middle finger) lateral and inferior to the anterior crest of the tibia. Use two 30-gauge, 2-cun filiform needles. Perform routine local disinfection, then insert perpendicularly to a depth of approximately 1.8 cun. Needling sensation: local distension and pain, or a radiating sensation toward the dorsum of the foot.

2. Methods

The patient is seated. The above points are needled according to the method, retained for 40 minutes, and then removed. The needles are manipulated (twirled) once during retention. Treatment is given once daily, with 10 sessions constituting one course of treatment, followed by a 5-day rest before the next course.

Commentary

For such patients, the aforementioned acupuncture treatment has a certain therapeutic effect. During the treatment period, patients are advised to maintain a relaxed mood and a cheerful spirit as much as possible, though a longer course of treatment is required. For adults presenting with athetosis after stroke accompanied by hemiplegia or quadriplegia, scalp acupuncture may be used as an adjunctive therapy. If the condition gradually progresses and worsens, and the above method proves ineffective, acupuncture should be discontinued promptly, and the patient should be transferred to the neurology department for further treatment.

Defining Athetosis: Etiology and Classification

What is athetosis? It is a movement disorder characterized by slow, involuntary, writhing motions, predominantly affecting the distal extremities such as the hands and feet. The condition is often classified into two major categories: idiopathic, where no clear cause is identified, and symptomatic, arising from structural or metabolic brain insults. Athetosis is most commonly associated with athetosis cerebral palsy, a subtype of dyskinetic cerebral palsy resulting from damage to the basal ganglia during perinatal development. The etiology remains incompletely understood, but it is frequently congenital, with clinical manifestations emerging within the first few months of life. The disorder is typified by bilateral athetosis, fluctuating muscle rigidity, and a variable degree of increased muscle tone, which may be accompanied by intellectual disability. Understanding the underlying pathophysiology—often linked to abnormal signaling in the extrapyramidal system—is crucial for distinguishing athetosis from other hyperkinetic disorders. This foundational knowledge informs both diagnosis and subsequent management strategies for affected individuals.

Clinical Manifestations and Athetosis Symptoms

The hallmark athetosis symptoms include slow, tonic extension-flexion movements that are continuous and often worsen with voluntary action or emotional stress. These involuntary movements typically affect the hands and feet, but may also involve the face, neck, and trunk, leading to grimacing, tongue protrusion, or postural instability. Muscle rigidity and hypertonia are common, yet they can alternate with hypotonic episodes, producing a fluctuating pattern. The movements are bilateral and symmetrical, though severity may vary. In many patients, athetosis is accompanied by increased deep tendon reflexes and, in some cases, associated intellectual disability. The presence of orofacial involvement is noteworthy, as abnormal movements in the face can interfere with feeding, speech, and social interaction. Early recognition of these symptoms is essential for prompt intervention. The natural history of athetosis is typically stable after early childhood, but secondary complications such as joint contractures or scoliosis may develop if abnormal postures persist without adequate management.

Therapeutic Strategies and Athetosis Treatment

Athetosis treatment is multidisciplinary and tailored to the individual’s symptom severity and functional needs. Pharmacological options include anticholinergic agents (e.g., trihexyphenidyl) to reduce involuntary movements, benzodiazepines to ameliorate muscle rigidity, and baclofen or levodopa in selected cases. However, drug efficacy is variable, and side effects are common. Physical and occupational therapy are cornerstones, focusing on stretching, strengthening, and adaptive techniques to improve motor control and daily living activities. In severe, refractory cases—particularly those linked to athetosis cerebral palsy—surgical interventions such as deep brain stimulation (DBS) of the globus pallidus internus or intrathecal baclofen pumps may be considered. Speech therapy and assistive communication devices are often necessary when orofacial involvement impairs verbal expression. The treatment goal is not to eliminate movements entirely but to optimize function, reduce discomfort, and prevent secondary musculoskeletal deformities. Long-term follow-up with a specialized neurology team is recommended to adjust interventions as the patient’s clinical status evolves. Early, consistent therapeutic engagement offers the best prognosis for improving quality of life.